Healthcare Provider Details

I. General information

NPI: 1548414030
Provider Name (Legal Business Name): RADAWN LEE ABRIEL RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2008
Last Update Date: 11/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2471 NW 185TH AVE
HILLSBORO OR
97124-7077
US

IV. Provider business mailing address

2992 NW OVERLOOK DR APT 1913
HILLSBORO OR
97124-6951
US

V. Phone/Fax

Practice location:
  • Phone: 503-690-9536
  • Fax:
Mailing address:
  • Phone: 503-866-8014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH5467
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: